ABSTRACT
According to the World Health Organization (WHO), mHealth applications are nothing but mobile apps that support medical treatment and public health activities through smartphone devices, patient monitoring gadgets, personal digital assistants (PDAs), and other forms of wireless network equipment. Digital technologies are becoming increasingly important in health care and public health delivery. Mobile wireless technologies are especially relevant due to their ease of use, broad reach, and widespread adoption. Mobile wireless technologies, specifically mHealth, have been shown to increase access to health information, services, and skills while also encouraging positive changes in health behaviors to prevent the emergence of acute and chronic diseases.
Mobile wireless technologies have been growing as a part of eHealth for the past decade. Mobile health apps can reach a wide range of people and solve specific needs in a variety of scenarios, with a variety of results, and supplement highly established healthcare technologies.
INTODUCTION: mHealth Helps in Obtaining Real-Time Patient Health Information
According to the World Health Organization (WHO), mobile wireless technology or mHealth for public health, is a component of eHealth. This indicates a cost-effectiveness and safe and secure use of information communication technologies in the health-related sectors. Mobile wireless technologies, for example, have the potential to transform how people interact with national health systems.
Digital health has been shown to improve access to health information, services, and skills and stimulate positive changes in health behavior to prevent the onset of acute and chronic diseases. Mobile health, or mHealth, is the use of wireless communication devices to improve public health and clinical practice. It is seen as a health enabler that benefits the health system by improving access and quality of care while also lowering healthcare costs. mHealth plays a key role in improving healthcare and providing practical benefits such as:
- Obtaining real-time patient health information to doctors in tracking the progression of diseases on the patient.
- Revolutionizing physical examinations.
- Growing access to quality health services.
- Increasing public access to reproductive and health services while also lowering mother, child, and neonatal mortality.
- Decrease in the premature mortality from non-communicable diseases and non-communicable disease comorbidities.
- Rising worldwide health security.
- Facilitating safe and high quality care by providing secure access to the information needed by the attending physicians at the moment of care.
- Increasing patient, family, and community engagement.
There are three primary categories of mobile devices that can be used to collect health-related data with today's mHealth technology: basic phones, handsets, and smartphones. Because the phone can be used to send and receive health-related data, this could be considered a telemedicine/telehealth extension. Because of the portability and convenience of use of mobile phones, medical advice can be sent while the patient is still at home or at the accident scene, saving time and money on transportation.
Advantages of mHealth
Despite the fact that digital health strategies and solutions have the potential to meet a wide range of patient and population requirements, governments have found it difficult to analyze, scale up, and integrate such solutions. Some elements that contribute to the same are:
- Individual applications are not networked, and there is no connection with current national eHealth policies and health information systems.
- There are no standards or tools for comparing the functionality, scalability, and value of rapidly expanding digital health systems, resulting in a paucity of evidence to express normative guidelines.
- There is a lack of a multisectoral strategy within government and among donor agencies, particularly involvement between ministries of health and information and communication technologies, as well as recommended engagement norms with mobile network operators and the business sector.
Technological interventions such as teleconsultation attempted to address the crisis on a continuous basis, but with limited success. Other technological advancements, such as mobile-based interventions (mHealth), have emerged in recent years. The use of telecommunications and multimedia technologies in conjunction with mobile and wireless healthcare delivery systems is referred to as mHealth. With success stories from around the world, it is clear that mobile technology has had a significant impact on health outcomes in the current scenario.
WHO has acknowledged the importance of information and communication technologies to health systems and services for more than a decade. This in turn has led to the growth in number of applications available in android, windows, and IOS platforms. Many resolutions on eHealth approved by the World Health Assembly and regional committees demonstrate the importance put on such technology. Therefore, WHO recently announced new goals in the field of digital health, specifically mHealth, which include:
- To update its existing strategic approach in order to better align its collective activities and future direction in the use of digital health in support of universal health coverage at all levels of the Organization, taking into account new potential areas of focus related to technical advancement in the field.
- To upgrade the data collecting and reporting method for the Global Observatory for eHealth.
- To create a knowledge base, best practices, and tools to assist Member States in implementing their digital health programmes.
- In order to enhance integrated person-centered health services and universal health coverage, to support and expand ongoing efforts to develop evidence-based guidelines on the use of mHealth.
- To provide mHealth and digital innovation guidelines and assessment frameworks to assist Member States in selecting, adopting, managing, and evaluating digital health solutions in order to aid good governance and investment decisions.
- As a means of achieving the Sustainable Development Goals, to collaborate with Member States and partners to develop platforms for sharing evidence, experience, and best practices in mHealth implementation. Building on existing networks to develop regional hubs of knowledge and excellence in mHealth could be one of them.
- To support the development of health workers' skills and empowerment to use information and communication technologies in order to foster involvement and responsibility, and to use mHealth to catalyze and monitor progress on specific Sustainable Development Goals.
WHAT OBJECTIVES HAVE BEEN LAID DOWN TO SOLVE THE PURPOSE OF THIS PAPER?
The objective of this review article is to use secondary data from research publications, journals, case studies, published articles, and other sources to discover answers to specific queries. The following goals are intended to be met by this research:
- Is there any benefits being arrived out of mHealth technologies?
- Has the integration of mobile technologies improved access to healthcare services and real-time, first-hand healthcare information?
- Have mobile healthcare technologies been able to reach the backward areas?
DATA ANALYSIS:
The systematic review decides the “impact of mHealth” on the healthcare system emphasizing on three metrics, including quality, access and cost. The main purpose of the review remains determination of mHealth’s impact across the healthcare system, despite the varying study designs, participants, intervention and geographical location with the use of one or more of the metrics. According to DATA BRIDGE MARKET RESEARCH, Global mhealth solutions market is expected to grow at a CAGR of 34.68% during the forecast period of 2021 to 2028. Increased penetration of smartphones, tablets and other similar gadgets is escalating the growth of the respective market.
mHealth includes the utilization of wireless communication devices to support clinical practice as well as public health. The technology aims at enhancing access and quality of health care, while declining the cost of health services. Health promotion programs, preventative programs, health information systems, and decision support systems are some of the health enabling tools that fall under the term Mobile health or mHealth. Mobile phones own a major part of mHealth solutions, hence the term Mobile Health. Data Bridge Market Research analyses that the mobile health (mhealth) solutions market was valued at USD 50.8 billion in 2021 and is expected to reach USD 1,952.9 billion by 2029, registering a CAGR of 50.0% during the forecast period of 2022 to 2029. The increase in demand for in remote patient monitoring is driving the growth of mhealth solutions market.
The number of mobile subscriptions has even outgrown the population size of some regions. There is a dearth of rigorous scientific evidence on the benefits of mHealth according to literature, exclusively in terms of randomized controlled trial studies.
In November’2015, a literature search was performed with the use of MEDLINE (accessed by PubMed), IEEE Xplore Digital Library. The search was restricted to studies in publication date (from January 1, 2000, up to the search data), humans, and publication language (English, Spanish, Portuguese, French, and Italian).
A common search strategy was used relevant studies were allocated to their respective reviews before assessing their risk of extracting data and bias. All studies were included in the software State of the Art through Systematic Review (StArt) where various combinations of the terms “systematic” and “review” identified systematic reviews by title or abstract. The same terms and parameters were used in an additional search in February’2016. The new search was structured more specific in order to make assessment manageable.
The cost-benefit analysis and effectiveness of eHealth interventions were included in the systematic reviews. The eHealth market is expected to witness market growth at a rate of 23.00% in the forecast period of 2022 to 2029 owing to the proliferation of high-speed internet across the globe according to the report curated by Data Bridge Market Research.
Exclusion criteria were studies regarding user acceptance, usability, or feasibility, studies that assessed nonsystematic reviews and “perceived benefits”. Initial screening was based on abstracts, articles and titles were independently evaluated. Abstracts that lacked information were retrieved for full-text evaluation. 2 investigators evaluated full-text articles independently to determine eligibility. Journal, years, or authorship were not blinded.
Data extraction was conducted by 5 investigators following standardized criteria, and results that were reviewed by 2 senior researchers. The data extracted included, publication year, time period, theme/specialty, intervention type, journal, databases searched, setting/scenario, objective, total number and countries of patients, study design, number of studies, whether a review of systematic reviews or meta-analysis was performed, main results, lessons and barriers for implementation, outcomes, and main limitations. The type and the perspective were also extracted.
Figure 1 shows flow diagram of literature search and study selection results. The database first search displayed 10,106 articles, and 572 articles, and 11 studies were found from additional sources. 625 articles were screened, 537 were excluded after exclusion of duplicates. 62 were excluded for not meeting the criteria relating to intervention, outcome or study type, out of reviewed 88 eligible articles. 3 studies were excluded for being included in a systematic review of systematic reviews. In this systematic review 23 remaining studies were included.
Figure 1. Flow of information through the different phases of the systematic review.
Source: The Impact of mHealth Interventions: Systematic Review of Systematic Reviews by Milena Soriano Marcolino ; João Antonio Queiroz Oliveira; Marcelo D'Agostino; Antonio Luiz Ribeiro; Maria Beatriz Moreira Alkmim; David Novillo-Ortiz
Descriptive Analysis of the Systematic Reviews
Between 2009 and 2016, 23 reports were published with the help of 16 journals. 371 studies were involved in the systematic reviews. At least 79,665 participants were included after verifying the sample size of each study. Systematic literature searches were performed from 1950 to April 2015 in these reviews. 17 included studies performed in low- and middle-income countries, 6 specified particular settings, 13 studies in multiple settings and 2 not describing the setting were included in the studies.
Apps for chronic diseases were the main focus of the mHealth modalities, along with treatment adherence, disease management, and changes in health behavior. A meta-analysis was performed on 9 studies. Smartphones, MP3, medical device connected to phone by cord or wirelessly, mobile phones, personal digital assistants, and phone plus app, among other devices were used.
SMS for education, prevention, reminders, or motivation was the most frequent intervention. Data collection, patient-provider communication, client education, training, voicemail, immediate physician feedback from a central location, disease management calls, automated email to clinicians, phone counseling, sensors and point-of-care diagnosis, provider-provider communication, decision support, provider work planning, protocol-based treatment, videos, cloud-based interactive voice response, disease monitoring, and phone counseling were also used. These interventions were performed for increase physical activity, chemotherapy-related symptoms monitoring, alcohol consumption reduction, appointment attendance, vaccination timeliness, reduction in emergency referrals or adverse events, cardiopulmonary resuscitation skills, social functioning, smoking cessation, chronic disease management, sexual health behavior safety, medication adherence, stress management and anxiety reduction, prenatal support, health information access, and patient satisfaction.
Hall et al categorized 12 common applications including, sensors and point-of-care diagnostics, data collection and reporting, electronic decision support: information, protocols, algorithms, checklists, provider work planning, human resource management, financial transactions and incentives, client education and behavior change, registries and vital events tracking, electronic health records, provider-provider communication: user groups and consultation, provider training and education, and supply chain management. In the duration of follow-up varied from a few minutes to up to 24 months, multiple interventions were used on significantly varied targets. The primary outcomes assessed were clinical outcomes, including symptoms, frequency of hypoglycemic events, and deaths, among others and surrogate outcomes, such as blood pressure, cardiovascular disease risk profiles, nebulizer use, body mass index [BMI], glycated hemoglobin [HbA1c], lipid profile, lung function tests results, and weight.
The behavioral or lifestyle changes include smoking cessation, and increase in physical activity. The process of care includes compliance with medication taking, communication performance, time to treatment, medication taking, communication performance, time to treatment and changes in professionals’ workload. Cost, potential harms, patient satisfaction, and adverse effects are categorized under secondary outcomes. A variety of results is shown in the reviews owing to the use of various devices and mHealth interventions on different populations. SMS addressed to chronic disease patients was the most widely used and successful intervention. Positive impact was reported on adherence to treatment and care, disease management, clinical outcomes, health behavior changes, and attendance rates, among others.
Some reviews displayed conflicting results, without significant differences between control groups and intervention. Hall et al mentioned studies that show advancement of diagnostic rates of dermatological conditions coupled with mobile teledermatology. Significant reductions in correct diagnoses compared to an onsite specialist was reported in the 2 trials using mobile phones to transmit photos to offsite clinicians. Reduction in quality of electrocardiography (ECG) transmitted via mobile phone to an ECG transmitted by fax was witnessed in 1 trial, but there were no effects on ECG interpretation. Fewer days to diagnosis and treatment were reported among individuals who were notified of test results through text messages.
Evidence of reduction was seen compared to control groups in following studies that assessed costs. SMS reminders were determined more cost-effective than telephone and they were equally efficacious. SMS was reported 35% and 45% less expensive, per attendance through reductions in telecommunications costs and research assistants’ work hours. The relative cost of the text message per attendance is said to be 55% and 65% of the cost of phone call reminders. A reduction in patient burden to transportation costs and time in African countries was seen. Benefits of mHealth was seen in chronic disease management, and enhancing symptoms and peak flow variability in asthma patients. The mobile health solutions are also highly beneficial in reducing deaths and hospitalization, glycemic control in diabetes patients, improving BP in hypertensive patients, heart failure symptoms, and improving quality of life. SMS reminders enhanced attendance rates at reduced costs. The reminders also assisted in improving adherence to HIV therapy and tuberculosis in some scenarios, with evidence of decrease of viral load.
Mobile devices may positively impact facilitating assistance in disease management and improve patient-provider communication. These devices increase the likelihood of delivering health interventions population in the remote regions. They have been proven highly beneficial in managing health conditions associated with women. Women's mHealth market is expected to gain market growth in the forecast period of 2020 to 2027. Data Bridge Market Research analyses the market to grow at a CAGR of 25.30% in the above-mentioned forecast period due to the rise in increasing consumer shift towards a healthy lifestyle and wellness therapies.
Data Bridge Market Research studied the systematic review on Current Status and Future Directions of mHealth Interventions for Health System Strengthening in India which aimed at studying and identifying the published mobile health (mHealth) or telemedicine initiatives in India in terms of their current role in health systems strengthening. This systematic review was conducted to analyze the initiatives based on the disease areas, geographical distribution, and target users. A detailed research of the literature was done to distinguish mHealth or telemedicine articles distributed between January 1997 and June 2017 from India. The electronic bibliographic data sets and vaults looked through included MEDLINE, EMBASE, Joanna Briggs Institute Database, and Clinical Trial Registry of India. The World Health Organization wellbeing framework building block structure was utilized to arrange the distributed drives according to their job in the wellbeing framework. Quality evaluation of the chose articles was finished utilizing the Cochrane chance of predisposition appraisal and National Institutes of Health, US apparatuses. The consolidated inquiry systems yielded 2150 citations out of which 318 articles were incorporated. A sharp increment was seen after 2012, driven basically by non-communicable sickness centered articles. Greater part of the essential investigations had their locales in the south Indian states. Administration conveyance was the essential focal point of 57.6% (72/125) of the chosen articles. A larger part of these articles had their attention on 1 (36.0%, 45/125) or 2 (45.6%, 57/125) areas of wellbeing framework, most often administration conveyance and wellbeing labor force. Over 91.2% (114/125) of the examinations, which coming up short on example size avocation, had utilized accommodation testing. Systemic thoroughness of the chose preliminaries (n=11) was surveyed to be poor. Taking everything into account, mHealth drives are by and large progressively tried to further develop medical services conveyance in India.
Data Bridge Market Research analyzed the study conducted by Wallace Chigona, Mphatso Nyemba-Mudenda and Andile Simphiwe Metfula who analyzed papers which zeroed in on mHealth, not those which basically referenced the subject in passing (for example to act as an illustration of versatile application). These researchers looked through the electronic variant of the 2012 M4D meeting procedures, utilizing watchwords 'mHealth' and 'wellbeing'. We physically read the papers to affirm that they fitted the standards. Studies or papers were incorporated assuming they were about cell phone innovation use for wellbeing administrations. Out of the complete of 62 papers in the procedures, we distinguished 13 papers as meeting our standards. Of the 13 papers in the corpus studied by these researchers, ten were about mediations in Asia (nine from India and one from Bangladesh). The mastery of papers from India was doubtlessly because of the area of the gathering; this was the example with every one of the papers at the meeting (most of papers at the gathering, 33 out of 62, were from India). The first and second M4D gatherings (2008 and 2010) had four and seven mHealth papers individually. TA full rundown of references for these 13 mHealth papers is given in the supplement.
RUNDOWN OF PAPERS USED FOR REFERENCE:
|
Authors
|
Technology
|
Focus
|
Application Area
|
Country
|
|
Batra et al.
|
SMS and Biometric
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Treatment adherence
|
Patient monitoring
|
India
|
|
Chaudhury et al.
|
Designed mobile phone application
|
Provision of health information
Drug interactions
|
Education/ awareness
|
India
|
|
Garai
|
n/a
|
mHealth application
|
n/a
|
India
|
|
Haque et al.
|
SMS and Medical sensors
|
Remote patient monitoring
Automatic assessment of patients' emotional and physical state
|
Patient monitoring
|
Bangladesh
|
|
Hoefman et al.
|
SMS
|
Health promotion
Medical male circumcision campaign
|
Education/ awareness
|
Tanzania
|
|
Jha et al.
|
SMS
|
Health promotion
Family planning
|
Education/ awareness
|
India
|
|
Khanna et al.
|
Mobile phone games
|
Health promotion
HIV/AIDS and TB awareness
|
Education/ awareness
|
India
|
|
Khurana et al.
|
SMS
|
Remote diagnosis and treatment
Remote patient monitoring
|
Connecting health workers and patient monitoring
|
India
|
|
Littman-Quinn et al.
|
n/a
|
Mobile Oral Telemedicine
Mobile Teleradiology
Mobile Cervical Cancer Screening
Mobile Teledermatology
Mobile Telementoring
|
Connecting health workers and patient monitoring
|
Botswana
|
|
Pundir et al.
|
|
Overview of mHealth
|
n/a
|
India
|
|
Pundir et al.
|
SMS
|
Proposal for mHealth use in medical schemes
|
Proposal for public health
|
India
|
|
Tegegne & VanDer Weide
|
n/a
|
Feasibility study
|
n/a
|
Ethiopia
|
|
Treatman & Lesh
|
Multimedia
|
ICT4CHW health promotion (counseling) by community health workers in maternal health
|
Connecting health workers and education/ awareness
|
India
|
Source: A review on mHealth research in developing countries by Wallace Chigona, Mphatso Nyemba-Mudenda and Andile Simphiwe Metfula
The researchers used the word frequency map constructed by using NVivo 8 to gain an overview of terms in the above given 13 papers. This survey gives an outline of the advancement of the mHealth space and examination progress in non-industrial nations. Data Bridge concludes that the outcomes affirm that contemporary mHealth intercessions have improved administrations. The administrations range from basically zeroing in on conveying mass wellbeing data utilizing instant messages, too far off information assortment, far off tolerant observing and self-administration, arrangement booking frameworks, as well as checking frameworks for analysis and treatment. mHealth drives appear to can possibly further develop admittance to and nature of wellbeing data and administrations. This might actually be a sign of what's going on the ground for example most mHealth projects are pilots with no reasonable procedure on how they can be up scaled. There is a need to break down execution methodologies, best practices and the adequacy of mHealth for huge scope executions. Further, research in the space has not zeroed in on the effect of the intercessions on the different partners. Most of endeavors to assess the intercessions have zeroed in on wellbeing markers. Further developed meticulousness would positively affect the nature of exploration and henceforth the effect of examination on strategy and practice. For all intents and purposes, the base up advancements of wellbeing laborers ought to be supported in mHealth execution, so all partners, including distraught networks, can add to the method involved with acknowledging wanted wellbeing results and prosperity. Such an interaction may likewise enable people and networks, prompting social change and worked on personal satisfaction. That would prove the case that mHealth could be an instrument for human turn of events.
FINDINGS AND CONCLUSION:
A growth in the popularity of mHealth is being witnessed, although the evidence for efficacy is still limited. It was seen highly useful for improving chronic pulmonary diseases symptoms and heart failure symptoms, enhancing quality of life, chronic disease management, reducing deaths and hospitalization, and advancements in glycemic control in diabetes patients and BP in hypertensive patients. In some scenarios, the attendance rates and adherence to tuberculosis and HIV therapy were improved through SMS reminders. However, the methodological quality of the studies included in the systematic reviews is low, and its impact is not evident or is mixed. The exceptions are the moderate improvement in attendance rates, smoking cessation rates, and asthma patients.
After conducting a fill fledged secondary research, Data Bridge Market Research concludes that this review provides an overview of the mHealth domain's progress and research progress in developing countries. Our findings confirm that modern mHealth interventions have improved services. The services range from simply delivering mass health information via text messages to remote data collection, appointment booking systems, and self-management, and diagnosis and treatment monitoring systems. mHealth initiatives appear to have enormous potential for improving access to and quality health information and services. However, studies on the effectiveness and impact of these interventions on the healthcare system and among clients are still lacking in the body of mHealth literature. The majority of mHealth studies only look at the technology's feasibility, implementation, adoption, usage, and acceptability.
Despite claims of potential benefits from mHealth, evidence on the acceptance and feasibility of this technology for large-scale deployment has yet to be established conclusively. The literature on mHealth implementations is still dominated by studies of pilot projects and those implemented for a limited time to address specific problems. This could be an indication of what is happening on the ground, namely that most mHealth projects are pilots with no clear strategy for scaling them up. From a research standpoint, studies on larger-scale mHealth implementations are critical. There is a need to examine implementation strategies, best practices, and the effectiveness of mHealth on a large scale.
Given that any conceptual framework did not guide the studies and that the research questions were not prompted by existing theories, it is suggested that future research should look for ways to improve the rigor of studies in the domain. Furthermore, research in the domain has not concentrated on the impact of interventions on various stakeholders. The majority of evaluation attempts have concentrated on health indicators. We contend that the social impact of mHealth interventions may extend beyond health indicators into other areas of society. Improved rigor would benefit research quality and, as a result, the impact of research on policy and practice.
Changes in both mHealth practice and research are required for improved mHealth effectiveness. Bottom-up innovations by health workers should be encouraged in mHealth implementation so that all stakeholders, including disadvantaged communities, can contribute to the process of achieving desired health outcomes and well-being. A similar process could also empower individuals and communities, resulting in social change and a higher quality of life. This would lend credence to the claim that mHealth could be a tool for human development.
According to the study, information about disease awareness, preventive measures, and nutrition are some of the needs of rural mobile phone users. Benefits such as reminders for adherence to medication and appointments with doctors seem to be well accepted by the rural mobile phone users. While older groups preferred voice calls over text messages, incorporating this into mHealth interventions may be necessary until the majority of the population is comfortable using the technology for purposes other than receiving and making calls. Women's health communication may aid them in making informed health decisions. Such communications will serve as wake-up calls to improve their health.
